A Field With Five Medications

In practice

The case is an orthopedic procedure on a shoulder, and the preference card lists five items for the field: a local anesthetic for the incision, a second local anesthetic of a different strength for the end of the case, warmed saline for irrigation, sterile water for the back table, and a dye the surgeon may use to mark tissue. Before the case, the scrub person, Ana, confirms the patient's allergies with the circulating nurse; the patient reports none. As each item arrives, the circulator and Ana read the name and strength aloud together. Ana labels each receiving container at once, using the generic name and strength, and places them in a fixed order on the back table, left to right in the order they will be used, with the two local anesthetics separated so that their similar syringes never sit side by side. The circulating nurse records each one. During the case, when the surgeon asks for the local, Ana reads the label aloud as she passes it: the drug name and its strength. Near the end, she tells the circulator how much of each was used, so the record matches what happened. When the case ends, everything left on the field is discarded according to facility policy.